Human Factors/Ergonomics (HFE) in Leadership and Management: Organizational Interventions to Reduce Stress in Healthcare Delivery — Oak Academic Publishing
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Human Factors/Ergonomics (HFE) in Leadership and Management: Organizational Interventions to Reduce Stress in Healthcare Delivery
Medical Faculty and Clinician Wellness Program, University of Rochester Medical Center, Rochester, NY, USA
1 Medical Faculty and Clinician Wellness Program, University of Rochester Medical Center, Rochester, NY, USA
Clinician Burnout is a personal and public health issue. Most occupational stressors contributing to clinician burnout are systemic. The combination of organizational interventions along with individual interventions is necessary to make significant lasting difference in reducing burnout, improving clinician and patient satisfaction and reducing latent error in healthcare delivery. Application of Human Factors/Ergonomics (HFE) science in healthcare leadership and management is a gap in current training for leaders. HFE uses concepts from organizational, educational and cognitive science, systems science and industrial engineering. HFE application is especially necessary in a fast changing highly stressful healthcare environment which impacts the wellbeing of clinicians and the safety of patients under care. Practical suggestions for working with various healthcare leadership styles and organizational dynamics, while aligning wellness efforts with institutional mission are discussed. Concrete examples of decreasing extraneous mental load on clinicians to preserve their brainpower to achieve quality patient care are illustrated. Organizational interventions in combination with individual interventions to reduce and manage burnout have enormous potential to improve clinician wellbeing and satisfaction in taking care of patients, reduce costs, risk of error and create the safe working environment needed to sustainably give high quality care to patients.
Patel, R.S., Bachu, R., et al. (2018) Factors Related to Physician Burnout and Its Consequences: A Review. Behavioral Sciences, 8, 98. https://doi.org/10.3390/bs8110098
Wurm, W., Vogel, K., Holl, A., Ebner, C., Bayer, D., Mörkl, S., et al. (2016) Depression-Burnout Overlap in Physicians. PLoS ONE, 11, e0149913. https://doi.org/10.1371/journal.pone.0149913
Dyrbye, L.N., Thomas, M.R., Massie, F.S., Power, D.V., Eacker, A., Harper, W., et al. (2008) Burnout and Suicidal Ideation among U.S. Medical Students. Annals of Internal Medicine, 149, 334-341. https://doi.org/10.7326/0003-4819-149-5-200809020-00008
Oreskovich, M.R., Kaups, K.L., Balch, C.M., et al. (2012) Prevalence of Alcohol Use Disorders among American Surgeons. The Archives of Surgery, 147, 168-174. https://doi.org/10.1001/archsurg.2011.1481
Appels, A. and Schouten, E. (1991) Burnout as a Risk factor for Coronary Heart Disease. Behavioral Medicine, 17, 53-59. https://doi.org/10.1080/08964289.1991.9935158
Centers for Disease Control and Preventions (2008) Exposure to Stress: Occupational Hazards in Hospitals. https://www.cdc.gov/niosh/docs/2008-136/default.html
Salyers, M., Bonfils, K., Luther, L., Firmin, R., et al. (2017) The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis. Journal of General Internal Medicine, 32, 475-482. https://doi.org/10.1007/s11606-016-3886-9
Privitera, M.R., Plessow, F. and Rosenstein, A.H. (2015) Burnout as a Safety Issue: How Physician Cognitive Workload Impacts Care. National Patient Safety Foundation e-News. http://npsf.site-ym.com/blogpost/1158873/224974/Burnout-as-a-Safety-Issue--How-Physician- Cognitive-Workload-Impacts-Care
Lyndon, A. (2015) Burnout among Health Professionals and Effect on Patient Safety. AHRQ PS Net. Perspectives on Safety. https://psnet.ahrq.gov/perspective/burnout-among-health-professionals-and-its-effect-patient- safety
Privitera, M.R. (2018) Is Burnout a Form of Depression? It’s Not That Simple. Medscape Psychiatry. Requested Commentary. https://www.medscape.com/viewarticle/896537
Privitera, M.R., Atallah, F., et al. (2018) Physicians Electronic Health Records Use at Home, Job Satisfaction, Job Stress and Burnout. Journal of Hospital Administration, 7, 52-59. https://doi.org/10.5430/jha.v7n4p52
National Academies of Sciences, Engineering and Medicine (2019) Taking Action against Clinician Burnout: A Systems Approach to Professional Well-Being. The National Academies Press, Washington DC. https://doi.org/10.17226/25521
Panagioti, M., Panagopoulou, E., Bower, P., et al. (2017) Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-Analysis. JAMA Internal Medicine, 177, 195-205. https://doi.org/10.1001/jamainternmed.2016.7674
West, C.P., Dyrbye, L.N., et al. (2016) Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Met-Analysis. The Lancet, 388, 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X
DeChant, P.F., Acs, A., et al. (2019) Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 3, 384-408. https://doi.org/10.1016/j.mayocpiqo.2019.07.006
Merlino, J. (2015) The Responsibility Matrix: A Strategy for Stronger Physician/Administrator Partnerships. https://www.beckershospitalreview.com/hospital-physician-relationships/the-responsibility -matrix-a-strategy-for-stronger-physician-administrator-partnerships.html
Privitera, M.R. (2019) Human Factor Based Leadership: Critical Leadership Tools to Reduce Latent Error and Burnout in a Time of Accelerating Change. Health, 11, 1224-1245. https://doi.org/10.4236/health.2019.119095
International Ergonomics Association. https://iea.cc/what-is-ergonomics/
White, W.L. (1997) The Incestuous Workplace: Stress and Distress in the Organizational Family. Hazelden Information & Educational Services, Center City Minnesota.
Martin, R. (2007) How Successful Leaders Think. Harvard Business Review, 85, 60-66. https://doi.org/10.1108/sd.2007.05623jad.007
von Bertalanffy, L. (1968) General System Theory: Foundations, Development, Applications. George Braziller Inc., New York.
Berwick, D.M., Nolan, T.W. and Whittington, J. (2008) The Triple Aim: Care, Health, and Cost. Health Affairs, 27, 759-769. https://doi.org/10.1377/hlthaff.27.3.759
Privitera, M.R. (2018) Addressing Human Factors in Burnout and the Delivery of Healthcare: Quality & Safety Imperative of the Quadruple Aim. Health, 10, 629-644. https://doi.org/10.4236/health.2018.105049
Bodenheimer, T. and Sinsky, C.A. (2014) From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine, 12, 573-576. https://doi.org/10.1370/afm.1713
Sikka, R., Morath, J.M. and Leape, L. (2015) The Quadruple Aim: Care, Health, Cost and Meaning in Work. BMJ Quality & Safety, 24, 608-610. https://doi.org/10.1136/bmjqs-2015-004160
Kohn, L.T., Corrigan, J. and Donaldson, M.S. (2000) To Err is Human: Building a Safer Health System. National Academy of Sciences, Washington DC. https://pubmed.ncbi.nlm.nih.gov/25077248/
Montgomery, A. (2014) The Inevitability of Physician Burnout: Implications for Interventions. Burnout Research, 1, 50-56. https://doi.org/10.1016/j.burn.2014.04.002
Shanafelt, T.D. and Noseworthy, J.H. (2017) Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 92, 129-146. https://doi.org/10.1016/j.mayocp.2016.10.004
Weisz, J.R., McCabe, M.A. and Dennig, M.D. (1994) Primary and Secondary Control among Children Undergoing Medical Procedures: Adjustment as a Function of Coping Style. Journal of Consulting and Clinical Psychology, 62, 324-332. https://doi.org/10.1037//0022-006X.62.2.324
Maslach, C. and Leiter, M.P. (1997) The Truth about Burnout: How Organizations Cause Personal Stress and What to Do about IT. Jossey-Bass, San Francisco.
Sweller, J., Ayres, P. and Kalyuga, S. (2011) Cognitive Load Theory. Springer, New York. https://doi.org/10.1007/978-1-4419-8126-4
MacNamee, K. (2020) Analysis: A Neurocognitive Approach to Developing Safer Medical Devices. Biomedical Instrumentation & Technology, 54, 28-36. https://doi.org/10.2345/0899-8205-54.1.28
Privitera, M.R., Rosenstein, A.H., Plessow, F. and LoCastro, T.M. (2015) Physician Burnout and Occupational Stress: An Inconvenient Truth with Unintended Consequences. Journal of Hospital Administration, 4, 1-8. https://doi.org/10.5430/jha.v4n1p27
Arnsten, A.F.T. (1998) The Biology of Being Frazzled. Science, 280, 1711-1712. https://doi.org/10.1126/science.280.5370.1711
Plessow, F., Fischer, R., et al. (2011) Inflexibility Focuesed under Stress: Acute Psychosocial Stress Increases Shielding of Action Goals at the Expense of Reduced Cognitive Flexibility with increasing Time Lag to the Stressor. Journal of Cognitive Neuroscience, 23, 3218-3227. https://doi.org/10.1162/jocn_a_00024
Wickens, C.D. and Hollands, J.G. (2000) Engineering Psychology and Human Performance. 3rd Edition, Prentice-Hall, Upper Saddle River, NJ.
Rock, D. (2009) Your Brain at Work: Strategies for Overcoming Distraction, Regaining Focus and Working Smarter All Day Long. Harper Collins Publishers, Broadway, NY.
Levitin, D.J. (2014) The Organized Mind. Thinking Straight in the Age of Information Overload. Penguin Random House LLC, New York.
Hart, S.G. and Staveland, L.E. (1988) Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research. Advances in Psychology, 52, 139-183. https://doi.org/10.1016/S0166-4115(08)62386-9
Sinsky, C.A. and Privitera, M.R. (2018) Creating a “Manageable Cockpit” for Clinicians: A Shared Responsibility. JAMA Internal Medicine, 178, 741-742. https://doi.org/10.1001/jamainternmed.2018.0575